Leaders of Mother-Baby care units throughout the system reviewed their professional certification status and identified opportunities for clinical staff development. Leaders identified that a low percentage of eligible nurses were certified. Kandace Turner, BSN, RN, RNCMNN, Nursing Supervisor, Boise Mother-Baby, contacted the Center for Nursing Excellence for assistance in identifying, consolidating and coordinating resources to assist nurses in preparing for their professional certification exam.
St. Luke’s Health System hosted a Maternal Newborn Nursing (MNN) Review Course on May 16-18, 2018. Working with The Center for Nursing Excellence and Human Resources, St. Luke’s was able to facilitate a batch registration and provided up-front payment for all St. Luke’s staff who attended the review course; 34 nurses from around the health system were able to attend this course. In addition, St. Luke’s hosted the paper/pencil test for the MNN Certification Exam on May 19, 2018, with nurses utilizing the Certification Program to seek reimbursement for test expenses. By hosting a test review course at St. Luke’s, the nurses were well prepared, and 100% of those who participated in the review course successfully completed their certification exam. Congratulations to all these nurses for pursuing and obtaining a professional nursing certification!
Supporting Transitions and Relationships (STAR) Nurse Residency is a foundational program for newly-graduated nurses with oversight by the Center for Nursing Excellence. The program is coordinated in the Treasure Valley by Denise Camacho, MSN, MAOL, RN, and in Magic Valley by Christiana Sipe, MSN, RN.
In 2018, the first groups of STAR residents participated in a new group performance improvement (PI) project designed around a concern or issue in their work environments. Identified problems align to PI initiatives across the system. Through thoughtful structure, PI coordinator team support, and program facilitator mentoring, the residents develop critical thinking, strengthen communication and improve professionally within nursing. The projects are designed to successfully set the new graduate nurse on the pathway to join shared governance, and to apply to the Nursing Research and Evidence-Based Practice Fellowship or Professional Advancement Through High-performance and Skill (PATHS) programs. Residents have reflected positively on their experience with the new performance improvement projects, calling it a “collaborative,” “thought-provoking” and “enlightening” experience.
Additionally, the STAR curriculum has been enhanced to include four uniquely-structured simulations to challenge the residents’ critical thinking skills and team collaboration. Through simulation and clinical nursing leadership, the STAR program supports residents as they successfully transition to competent professionals by helping them to use effective decision-making skills, incorporate research-based evidence into practice, strengthen their professional commitment to nursing and formulate plans for next steps in their careers. Residents are awarded Continuing Nursing Education credits for their hours in STAR to supplement their professional growth.
The 2019-2020 year will see many continued enhancements to the program in preparation for accreditation, while aligning to the needs of the millennial new graduate nurse.
After leaving the emergency department (ED), many patients may have questions or not remember all their discharge instructions. In Fruitland, patients now get a reassuring phone call from an ED clinical nurse to check on their general health, ensure follow-up care and assist with prescription management. The program design was inspired by other EDs around the heath system, including a very successful callback program in Wood River.
The goal of the Fruitland callback program is to provide personalized attention, listen to patient concerns and ensure that patients get the follow-up care they need, says Joe Young, BSN, RN, CEN, Fruitland ED Nursing Manager. “It gives us a chance to strengthen the bond.”
Within two days of an ED visit, patients receive a followup call. Prior to the call, the clinical nurses access the patient’s electronic health record, review provider notes and read prescription follow-up instructions. During the call, patients are asked about their general health, issues filling prescriptions and the status of followup appointments with primary care physicians and specialists.
Young says the program is successful because it is collaborative. He gives credit to his colleagues Sheri Davis, Health Unit Coordinator; Bailee Jones, BSN, RN; Brianne Haun, MSN, RN; Randy Spurgeon, Respiratory Therapist; and others. He is proud of the Fruitland team’s willingness to take the extra steps needed to improve
outcomes for patients.
“When everybody is happy, you give better care,” Young says.
Celeste Benedict, BSN, RN, CMSRN, a Nampa ICU nurse, was nominated for Idaho’s Brightest Stars Award. The nomination stems from a program she created to provide clothing upon discharge to patients with limited resources. Benedict developed the Clothes Closet program in response to a growing problem at the Nampa hospital. Some patients have blood-stained or bug-infested clothes that are removed during treatment.
Although patients receive hospital-issued gowns, not all of them have friends, family or resources to shop for new apparel upon discharge. “We do not want to release them in hospital gowns,”Benedict says. “We want the patients to have some dignity.” She got the idea from a previous employer in Portland, which has a large homeless population. While Nampa is significantly smaller, Benedict recognizes that the availability of clean clothing is still an issue for some of her patients. “Just because it is not a big city does not mean there is not a need.”
Benedict mobilized the hospital’s all-volunteer Community Service Committee to start the Clothes Closet. Housed in cupboards in the emergency department hallway, the Clothes Closet is accessible to providers and clinicians throughout the building. St. Luke’s employees have been donating new and gently used clothing for children and adults. Dozens of shirts, pants, shoes, socks, underwear, belts and other accessories line the shelves.
St. Luke’s McCall Emergency Department (ED) achieved Level IV trauma designation in 2018, making it the first hospital in the system to receive this designation. The project was led by nursing leader Jackie Hurzeler, MSN, RN, MSCRN, but required every department in the McCall hospital to participate. Key to the accreditation success was a cultural shift early in the program development with strong support from clinical nurses and ancillary staff.
Hurzeler led the team in creating policies, procedures, care guidelines and processes to support a Level IV center. Early engagement with key stakeholders led to increased efficiency. Building strong relationships with St. Luke’s Transfer Center and St. Alphonsus resulted in a streamlined and standardized approach for transferring patients to a higher level of care.
Once the transfer process was revised, the focus shifted to identifying the members of the trauma team and their individual roles, defining trauma activation criteria, and determining how to activate the trauma team. Development of the Performance Improvement and Patient Safety Plan was key in physician engagement.
Once the foundation was laid, a comprehensive education plan was designed and implemented for every role. The McCall team partnered with Clinical Learning and Student Services and the simulation team to bring TeamSTEPPS fundamentals to McCall. With TeamSTEPPS trauma simulation for all interdisciplinary team members, tremendous improvements in the care provided for trauma patients have been noted.
Trauma activations began on January 1, 2018. Early experiences provided valuable learnings and insight to support fine-tuning trauma response. Activation criteria was redefined to be broader, but specific to the types of trauma seen in the McCall ED. For example, criteria changed from “ejected from a horse” to “ejected from
any animal” (e.g., rodeo bull).
Continuous improvement is a key to maintaining trauma designation and the McCall team instituted a plan to ensure success, including continued work with the trauma program manager and ongoing participation of nursing leadership in trauma activations in the ED and in medical/surgical patient rounds.
Fruitland 4-H members got a behind-the-scenes tour of hospital services recently, thanks to the St. Luke’s Fruitland Emergency Department. The Lucky Clover 4-H members are 8 to 14 years old and recently completed first-aid and CPR training. On December 1, 2018, they visited with the Payette County Paramedics to learn about the dispatch process and ambulance services. Later that day, they visited St. Luke’s Fruitland Emergency Department and took part in hands-on learning in radiology, respiratory therapy, nursing and other areas.
At St. Luke’s, they viewed old X-rays, peered into a microscope, studied lab tests and learned about intubation and chest compressions. They even practiced racing down a hallway with “Bruce” the manikin during a mock “code blue.”
“Emergency rooms can seem a little scary to kids,” says Joe Young, BSN, RN, CEN, St. Luke’s Fruitland ED Nursing Manager. “It was fun for them to see what we do.” St. Luke’s Fruitland Security Officer Kraig Galloway and his wife, Jennifer, are co-leaders of the 4-H group. Their daughter, Ruth, is a member. Galloway says the tour was timely. “It was really neat and interesting for them because it cemented their training,” he says. “They understand what it means to do a Heimlich maneuver, save someone’s life and then dial 911. The kids were very appreciative.”
The tours opened the children’s eyes to future careers as doctors, nurses and paramedics. “We have new recruits!” Galloway says.
St. Luke’s Eagle Medical Plaza was opened in April of 2008 as an outpatient center offering services for patients at a location close to home with convenient hours. The Eagle Urgent Care nurses have continued to be true to that mission, providing care to patients with minor illness and injuries until 10 p.m., seven days a week.
In addition to caring for patients who are ill or injured, our urgent care nurses work to meet St. Luke’s mission of improving the health of people in the communities we serve by administering flu vaccines on a walk-in basis to approximately 300 patients annually. This is a benefit to our community as people don’t have to miss work to get protected against the flu and families can come together to get vaccinated.
Eagle Urgent Care became a clinical site for Meridian Medical Charter Arts High School shortly after opening. Students who are interested in health care careers earn either a certified nursing assistant (CNA) or emergency medical technician certification during their high school years.
Eagle Urgent Care has become a favorite clinical location for the students as they get to work with a variety of professionals to hone their skills, from registered nurses and nurse practitioners to physician assistants and CNAs. This partnership has led to Eagle Urgent Care being in the fortunate position to hire some of the students when they finish high school to work as CNAs while they continue their college career.
In 2018, the American Heart Association released new guidelines for blood pressure (BP) measurement. This new evidence led to a system-wide change in clinical practices. The materials for the ambulatory clinic education were developed by Christiana Sipe, MSN, RN, Clinical Educator.
Prior to developing the education, Sipe’s assessment of the situation noted variation in how BP measurements were obtained and equipment used. St. Luke’s clinics employ medical assistants, licensed practical nurses, RNs, and athletic trainers who perform patient intake, or “rooming a patient.” In most locations, the clinical staff measure BP as a component of the intake process, which means St. Luke’s clinics are measuring hundreds of blood pressures every day. Practices within the clinics vary, with some taking BPs manually and others using automated devices or a combination of the two. The brand of the equipment and types of cuffs and sizes was also different from site to site.
Sipe used this information to develop the evidence-based educational content which included teaching about the implications of using an incorrect cuff size, and information about how to choose the correct one for their patient, regardless of the brand. Clinical staff attended one of four live educational webinars in April 2018, and/or viewed a recorded version at a later time. Over 600 clinical staff from across the system received the webinar education, including approximately 150 RNs.
This year's report highlights the accomplishments and exemplary outcomes of our talented nurses.
Our 2016 report expanded to include the entire St. Luke's Health System for the first time, including our successful implementation of a system-wide electronic health record.